RT Journal Article
SR Electronic
T1 Competency for Creation, Use, and Revocation of Psychiatric Advance Directives
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 501
OP 510
VO 34
IS 4
A1 Debra S. Srebnik
A1 Scott Y. Kim
YR 2006
UL http://jaapl.org/content/34/4/501.abstract
AB Psychiatric advance directives help promote patient involvement in treatment and expedite psychiatric care. However, clinicians are unsure of how to use directives, partly due to poor clarity regarding standards for capacity to create, use, and revoke them. This article recommends possible capacity standards. Capacity to create directives is a legal presumption, supported by empirical data. Standards are discussed for the subset of cases in which capacity assessment is needed. Use of directives may be triggered by incapacity to provide informed consent to treatment, although tailored, individualized points of activation may also be considered. In many states, revocation of a psychiatric advance directive requires adequate decision‐making capacity. Setting a capacity standard for revocation presents challenges, however, in light of obstacles to providing treatment when revocation is attempted and the fact that many patients prefer revocable directives. As more directives are created and used, additional research and statutory refinements are warranted.